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HomeMy WebLinkAboutSWG Application / Design - 3/7/1957 zzb5S1o00 6 No. 196 THURSTON-MASON DISTRICT HEALTH DEPARTMENT Court Douce Annex Division of Sanitation Court House Annex Shelton, Washington Olympia, Washington Telephone 6-S515 Telephone 2-4551 APPLICATION TO CONSTRUCT OR ALTER AN INDIVIDUAL SEWAGE DISPOSAL 5Y EM /��,//�(Applicatipl n Requiredm/T for E/a}'h Installation) Property Ownor 14 et7;0 Y s 7: Ce.sr cy Te lephono (Please Print) 7 Address tkl Mailing 4o 0 7 -- 2 7. %-�*,�.K- of site - A7/Ge--a-✓-- iia Location of Property, Including.; Lots,lock $ 1� j (detailed di rerti ens to f' Sdt) Aa z' , Property/ / �' Commercial �.� Size @ 0 ,i-r0 Residence ) No. Bedrooms I Basement Type CWater Supply: Public_, Well_, Spring_, Other £kt a/z_ i Is any water supply or body of water within 50 feet of sewage atom? Yee o SKETCH PLANS AS DESIGNATED ON BACK SIDE OP THIS SHEr�ET. Septic Tankk'.3© vallons. Drainage System Length /J feet. Trench Width 0 And/or other F.H.A: Yes No X . Check for In- stallation of: Automatic laundry Okla) , Automatic dishwasher (4o), Garbage grinder(96 Is Contractor installing septic tank? Yes No X ; Drainfieldt Yes I No if- . Name and address of Sewage Contractor: CTHE UNDERSIGNED hereby applies for a permit to construct a new and/o alter ( ) a sewage system on above property. The construction and speoifica ions afe to be in accordance with the ^Minimum Requirements and Standards Regulating Sanit }_v Sewage Disposal in Thurston-Mason Countiee., Applicant's „/. , ( y'G/ �' pi Signature: Iff/�(6+/ Address: W'��� � / NOTE: Please refer t "Minimum Requirements and Standards Regulating San tary Sewage Disposal" and the accompanying dra..'ings. (Not to be filled in by applicant) f Permit No.NLY ��iisi Fee $5.00 Date issued _.J-/� '-�7 By �A�-- Area __Sanitarian __ Dates inspected 3 " ? - 5 7 Remarks MOM. n Aitd q {Pva n ,: iS!�, r ., ::.:,? 7'ed byrr (Ontin SKETCH AND DESIGNATE THE FOLLOWIIIG: 1. Property lines and names of streets. 2. Locate all building, driveways, septic tank and/or other, drainfieldr distribution box and trees. 3. Dimensions of septic tank and dreinfield. 4. Location of and distance to any stream➢ lake, Puget Sound, or other bodies of water within 100 feet of sewage system. 5. Location and type of wells or other water supplies within 100 feet of sewage system. N W E CO " C� \ I Y e % ' �1 \ <e0o � of et 0 \ / 0 \c4/ V a.